Directive to Physicians and Family or Surrogates requirements in Texas

Which document is this, really

In Texas, the living will has an official name most people never hear until they need it: the Directive to Physicians and Family or Surrogates. It is a written statement of the treatment you do and do not want if you are ever unable to speak for yourself. Texas keeps a second, separate statutory document for naming someone to decide on your behalf, called the Medical Power of Attorney. The person you name in it is your agent.

The two are not the same paperwork. Texas law does let you name a decision-maker inside the Directive itself, so a light form of combining is technically possible. But the dedicated, more detailed instrument for that job is the Medical Power of Attorney, kept apart from the Directive on purpose and carrying its own disclosure statement about what naming an agent means. The two documents share a signing rule; where they differ is the form. Texas says a written directive “may” be in the form the code prints, and forbids a physician or facility from making you use theirs, so you are not tied to that wording. The Medical Power of Attorney is stricter: it must be in substantially the form the statute sets out.

This is exactly the pairing Myend’s Healthcare Directive prepares for Texas: a Directive to Physicians for your wishes, and a Medical Power of Attorney for your agent, each formatted the way Texas expects it.

Who can make a Texas advance directive

Texas asks one thing of you: that you are a competent adult, meaning 18 or older and able to understand what the document says and does. Competence here is a practical standard, not a medical certification you need in hand before you sign. It means you understand what the Directive says, what it does, and what it means to name an agent, at the moment you sign it. A parent, guardian or spouse can execute a directive on behalf of a patient younger than 18, but that is a decision made for the minor, not one the minor makes for themself.

Signing it so it counts

Texas runs two separate signing ceremonies, one for each document. Do not mix them up: a witness who is fine for one may not be fine for the other, and neither document borrows its rule from the other.

The Directive to Physicians and Family or Surrogates

1. 1You sign

   You sign the Directive, or direct someone to sign for you in your presence.

2. 2Two witnesses, or a notary

   Texas gives you a choice. Sign in front of two qualifying witnesses, or skip the witnesses entirely and have your signature acknowledged before a notary public instead. Either one makes the Directive valid.

3. 3If you use witnesses

   At least one of your two witnesses must not be: a person you named to make health decisions for you, a relative by blood or marriage, someone who inherits any part of your estate under a will or by operation of law, your attending physician, an employee of your attending physician, an employee of the health care facility treating you who provides your direct care (or an officer, director, partner, or business-office employee of that facility or its parent organization), or anyone with a claim against your estate.

If you choose the notary route instead, the witness lines are replaced by a notary acknowledgment block, and you do not need witnesses at all.

The Medical Power of Attorney

Naming your agent is a separate signing, on its own paper, and Texas gives it the same choice it gives the Directive. Section 166.154 requires the Medical Power of Attorney to be signed before two witnesses who qualify under Section 166.003, at least one of them from the restricted category above, or, in place of the witnesses, signed and acknowledged before a notary public. The statutory form spells it out in capitals: the power of attorney is not valid unless you sign it before a notary or before two competent adult witnesses.

Naming your agent

The Medical Power of Attorney is where you name your agent, the person authorized to make health care decisions for you once your directive or your incapacity takes effect. Texas law does not hand you a long eligibility list to sort through. It disqualifies only a narrow group of people from actually exercising that authority: your own health care provider, an employee of your health care provider (unless that employee is your relative), your residential care provider, or an employee of your residential care provider (unless that employee is your relative). Anyone else you trust can serve.

When it takes effect

The two documents switch on differently. The Directive to Physicians applies once you become what Texas law calls a qualified patient: your attending physician has diagnosed and certified, in writing, that you have a terminal condition (incurable, and expected to cause death within six months even with treatment) or an irreversible condition (treatable but never curable, leaving you unable to care for yourself or make decisions, and fatal without life-sustaining treatment).

Your agent’s authority under the Medical Power of Attorney switches on separately: your attending physician must certify in writing, and file that certification in your medical record, that you are incompetent. Until that certification exists, your agent has no authority to act.

If you are pregnant

Texas law sets the Directive to Physicians aside for the rest of a pregnancy. The statute is one sentence long and it carries no conditions at all: nobody may withdraw or withhold life-sustaining treatment under this subchapter from a pregnant patient. It does not turn on viability, it does not ask how far along the pregnancy is, and it does not ask for a second medical opinion the way several other states do. It sits in the Directive’s own subchapter, so it is written as a limit on the Directive; the exact wording is in the sources list below.

Changing or cancelling it

You can revoke your Directive to Physicians at any time, regardless of your mental state or competency, in any of three ways: physically destroying it (canceling, defacing, burning, or tearing it up), signing and dating a written statement that says you revoke it, or simply telling someone orally that you revoke it. A written revocation takes effect once your attending physician is notified, and the physician has to note the date and time and mark existing copies void; an oral revocation works the same way, on notification. Nobody is liable for failing to honor a revocation they did not actually know about.

The Medical Power of Attorney is revoked its own way, under its own section: tell your agent or a health or residential care provider, out loud or in writing, or do anything else that clearly shows you mean to revoke it, or sign a new one. Signing a new Medical Power of Attorney replaces the old one, and if your agent was your spouse, a divorce or annulment ends their authority unless the document says otherwise.

Making sure it is found

Texas keeps no state registry of individual directives or medical powers of attorney. The section of the health and safety code that mentions a “registry” is actually a directory of hospitals willing to accept patient transfers, not a place where your own documents are filed. That makes copies your real safeguard: give one to your agent, your physician, and the hospital you are most likely to use, and keep the signed original somewhere your family knows to look.

A directive nobody can find is functionally the same as no directive at all. The most common failure is not a missing signature, it is a document sitting in a drawer at home while the decision is being made in an emergency room. Naming your agent, then telling them plainly where the paperwork lives, closes most of that gap without any state system to lean on.

If you are treated in Texas but signed your directive somewhere else, Texas law says an advance directive validly executed in another state is given the same effect here as one signed under Texas law, as long as it does not ask for anything Texas law itself prohibits.

This is not a POLST

Texas’s medical order program is generally known as the Texas POLST: A Portable Medical Order. It is not the same kind of document as your Directive to Physicians. A POLST is a set of specific medical orders, signed by a clinician together with someone already facing serious illness, meant to travel with that person between hospital, nursing facility, home and ambulance. A directive, by contrast, is something you fill out in advance, for a future you cannot yet see. Myend prepares the Directive to Physicians and the Medical Power of Attorney. It does not, and cannot, produce a POLST, because that has to come from a treating clinician.

What is different about Texas

Texas hands you two documents instead of one, then gives you the same choice on both: two witnesses, or a notary.

Texas is a two-document state through and through. The Directive to Physicians carries your treatment wishes; the Medical Power of Attorney carries your choice of agent; and the law never lets the two borrow from each other. Both are unusually flexible on signing, letting you trade two witnesses for a single trip to a notary, and both draw their witness rules from the same section of the code. What you cannot do is let one document stand in for the other.

The pregnancy rule is equally plain-spoken. Texas does not soften it with a viability test or a second physician’s opinion the way several other states do. The Directive is set aside for the rest of a pregnancy, in one sentence, with no conditions attached. And if you are ever treated for a serious illness in Texas, remember that your Directive and the Texas POLST are not interchangeable. One is your plan; the other is the order your clinician writes once that plan needs to become a set of instructions at the bedside.

None of this makes Texas an unusually hard state to plan in. It is a state that hands you two documents instead of one, each doing a narrower job than a single combined form would, and each with a signing rule that fits that job. Once you know which document you are signing, the rest of it is straightforward.

Common questions

Sources and review